Background: Ischemic heart disease remains the first killer and common silent disease in the world. The lipid profile plays the essential role in ischemic heart disease development via atherogenesis process by depositing inside coronary arteries wall with lipid oxidation, which leads to artery narrowing then blockage.Aim of the study: To estimate the prevalence of triglyceride and high density lipoprotein cholesterol ratio among 100 acute coronary syndrome patients and compared to among a sample of 100 control persons.Methodology: Blood samples were taken from sample (n=100) of acute coronary syndrome inpatients from coronary care unit, and control (n=100) of non acute coronary syndrome outpatients recorded during the period from 1/7/2013 to 30/11/2013 at Baghdad Teaching Hospital. The patients'age , sex , body mass index , waist circumference, diabetes mellitus, hypertension, smoking, previous history of ischemic heart disease and types of acute coronary syndrome were collected by questionnaire, hospital administration and nursing data in coordination with the department physicians. SPSS version 15 was used as the tool for statistical analysis.Results: The mean age was 60.7±8.2 years in patients group and 58.3±9.3 years in control, and there were 63 males and 37 females in patients group compared to 64 males and 36 females in control group, P>0.05. The mean waist circumference in male patients was 96.5 ± 12.7cm and in control it was 93.5 ± 8.1cm . Among female patients the waist circumference was 93.3 ± 11.9 cm , compared to 86.6 ± 6.4 cm in control, P>0.05 . The mean body mass index in patients was 27 ± 2.8 kg/m 2 and in control it was 26.7 ± 4.7 kg/m 2 , P>0.05. Among patients the smokers were 57 cases while among control they represented 46 smokers , P>0.05. Regarding distribution of risk factors, hypertension , diabetes mellitus and ischemic heart disease were 161 present in 47, 36 and 32 patients respectively, and it were present in 35, 28 and 21 control, respectively, P>0.05. The prevalence of types of acute coronary syndrome among the patients, 36 had unstable angina, 33 had STelevation myocardial infarction and 31 had Non ST-elevation myocardial infarction. The mean high density lipoprotein cholesterol in male and female acute coronary syndrome patients was lower than that of control, it was 37.5 ± 9.4 mg/dl in male patients vs. 48.6 ± 7.3 mg/dl in male control, and 37.1 ± 7.8 mg/dl in female patients vs. 51.1 ± 9.3 mg/dl in female control, P<0.001. The percentage of triglyceride (≥150 mg/dl) in the study was (72%) among acute coronary syndrome patients , and (<150 mg/dl) was (28%) in acute coronary syndrome patients , while in control persons ,triglyceride (≥150 mg/dl) was (30%) , and (<150 mg/dl) was (70%) among control persons. The percentage of High density lipoprotein cholesterol (<40 mg/dl) in male patients was (42%) and (≥ 40 mg/dl) was (21%) , and in female patients (< 50 mg/dl) was (36%) and (≥ 50 mg/dl) was (1%). The mean triglycerides showed a significant differences in different type groups o...